Circumcision Paper

By Anonymous · Jan. 01, 2003

"Nothing is so firmly believed as what we least know." Michel de Montaigne

The debate over routine infant circumcision is intense, with both sides having their own share of fanatics, overzealous individuals, and opinions. What are often missing from this debate however, are facts. The amount of outdated, misleading, and incorrect information being passed on to today's parents is staggering. Parents are often pressured into signing consent forms for a procedure that they know nothing about. This paper will outline the traditional reasoning used to justify circumcision and explain why those reasons are invalid. Routine infant circumcision is an unnecessary, dangerous, and harmful procedure that must be stopped.

A major problem with circumcision is the lack of quality information on the topic. Parents are asked to approve a procedure for their sons that they do not fully understand themselves. In a recent survey of 60 graduate students, thirty-eight percent of the women and forty-five percent of the men were unsure of the difference between a circumcised and intact penis (Goldman 30).

False information on circumcision has been spread in this country since the 1800's when circumcision was recommended to prevent insanity and epilepsy. Some doctors began attributing diseases and medical problems solely to the presence of a foreskin (Ritter 23). As bizarre as this sounds, such misinformation continued into the 1940's when circumcision was recommended to stop the spread of sexually transmitted diseases and in the 1950's circumcision was the supposed cure for cancer. Circumcision has been recommended throughout history as the cure for whatever incurable disease held the national spotlight at the time like in the 1980's when circumcision was going to stop the spread of AIDS (Burton 42).

The current fallacy being spread to excuse circumcision is that the circumcised penis is cleaner and easier to take care of, therefore reducing the risk of urinary tract infections (UTI). The American Academy of Pediatrics (AAP) has dispelled this myth by concluding that studies showing uncircumcised males to be more prone to UTI are flawed and retrospective (Ritter 32). Even if one were to accept these flawed studies as fact, that would still mean that 96-99 percent of uncircumcised males do not get UTIs in the first year (Goldman 30). Considering that a UTI is treatable with antibiotics, it is poor medical reasoning to cut off healthy, natural tissue to prevent a problem that will not likely become an issue. Circumcision to prevent UTI is like pulling healthy teeth to prevent cavities, it works but at a great cost.

It is clearly not necessary to circumcise to prevent UTI. It is actually beneficial for a man to have his foreskin intact for health reasons. When you circumcise a child, it is impossible to prevent the glans from being soiled by feces. The open wounds created by circumcision being exposed to fecal contamination and possible infection compound this problem. Doctors often downplay the very real risks of circumcision to new parents. The rate of surgical complications is reported to be from 0.2 to 38 percent. The higher rate takes into account complications related to the circumcision in the infant's first year (Goldman 30). A 10-year study of circumcision risk in one hospital showed that "most complications" were not even recorded on patient charts (Wallerstein 148). Complications can include infection, surgical injury, scarring, deformities of the penis, or even death (Goldman 31). Hemorrhage is also a common problem encountered with circumcision. Bleeding from the frenular artery, if it goes undetected for even a short time, can be fatal for a 6.6 pound infant whose total blood volume is only eight ounces (Ritter 5). In a very small number of cases, the entire penis has been lost due to circumcision complications such as infection and the improper use of an electrocautery unit (Ritter 5).

Pro-circumcision advocates fail to acknowledge that the foreskin is a functional and perfectly normal part of the male anatomy. In infancy that foreskin protects the glans, or head, the penis from feces and abrasive diapers. The foreskin continues to protect the glans throughout a man's life by shielding it from rubbing against clothing and zippers. Many parents also do not realize the diminished sexual sensitivity that they are inflicting on their sons. The adult foreskin is approximately 12 square inches of sensitive penile skin, or almost the size of a 3 x 5 index card. With a total area of 33 square inches of skin on the intact penis, a man loses over a third of his penile skin, with half of that being erogenous mucous membrane (Ritter 18). R.T., from Denver states, "I was deprived of my foreskin when I was 26; I had ample experience in the sexual area, and I was quite happy (delirious, in fact) with the pleasure I could experience as an intact male. After my circ umcision, that pleasure was utterly gone. Let me put it this way: On a scale of 10, the uncircumcised penis experiences pleasure that is at least 11 or 12; the circumcised penis is lucky to get to 3."

Doctors continue to tell parents that their sons are not in pain during circumcision and that it is merely a mild discomfort, yet during circumcision all babies scream, tremble, or cry. Some children hold their breath or even vomit during the procedure from the "mild discomfort." It is not uncommon for an infant to cry for hours and remain irritable for days afterwards (Ritter 3). When a heel stick is done to an infant, the child's behavioral response will be to pull the foot away and cry. Some infants may even use their free foot to kick the doctor's hand away. This is a biological response to pain. Levels of cortisol, a hormone released by the body in response to stress, have also been measured during circumcision and also in other procedures performed on newborns. The levels of cortisol present during a circumcision are dramatically higher than during any other procedure (Goldman 20). Because many doctors continue to deny the evidence proving an infant has the abi lity to feel pain, the procedure itself is done primarily without the benefit of an anaesthetic though even if one were used the effects would only last for an hour or two. Full anesthesia is not practical for an infant and local anaesthetic can cause swelling and distort the already small area being operated on. Therefore, infants must go through a procedure that no adult would be willing to undergo without anesthesia.

Numerous professional health groups have already taken these reasons into account. The American Academy of Pediatrics has maintained since 1971 that "there is no absolute medical indication for routine circumcision of the newborn. A program of education leading to continuing good personal hygiene would offer all the advantages of routine circumcision without the attendant surgical risk. Therefore, circumcision of the male neonate cannot be considered an essential component of adequate total health care." The American College of Obstetrics and Gynecology has supported the AAP in their stance against routine circumcision since 1972. By saying that good personal hygiene would offer the same advantages as circumcision, the conclusion can be drawn that a bar of soap could be substituted for a scalpel. Doctors frequently have vested interests in the circumcision debate that prohibit them from informing parents. For circumcision to be stopped, doctors would have to admit tha t what they were doing was wrong. Johns Hopkins University Hospital however, has announced that neonatal circumcision would no longer be performed unless specifically requested by the parents (Ritter 36).

The stance taken by Johns Hopkins is admirable because the cost of a single circumcision can be upwards of $200. Too many doctors look at a foreskin and see a dollar sign. In the United States, doctors collect as much as $240 million yearly to perform 1.2 million unnecessary circumcisions on 1.2 million normal, healthy penises. In England, before the switch to socialized medicine was made in 1948, there was a high circumcision rate. After the switch when doctors were no longer compensated for circumcision, which was deemed a cosmetic procedure, the circumcision rate fell to 0.5% (Ritter 29).

In no other operation does the layperson make the exclusive decision to operate. This decision is based on informed consent, which by name suggests that the parents should be fully informed on the risks but this is rarely the case. Many mothers are unsure what the procedure entails, what the difference is between a circumcised and uncut penis is, and sometimes even their own husband's circumcision status (Wallerstein 94). An information sheet distributed to new parents at Brigham and Women's Hospital in Boston is full of glaring inaccuracies. They say that circumcision is an American custom, with 80% of male newborns being circumcised, which overstates the actual rate by 20%. They also state that it was once believed that circumcision lowered the rate of cervical cancer in the male's sexual partner, though no relationship has been shown in recent studies. Obviously, given that Brigham and Women's Hospital admits that there is no factual base for the cervical cancer arg ument, it should not be included in the information. There are several court cases pending in the United States regarding circumcision including a lawsuit filed by 19 year old William Stowell. Stowell claims that the informed consent given by his mother was while she was under the influence of Demerol and other drugs given to her to ease the pain of childbirth. Stowell is suing the obstetrician who circumcised him and the hospital in which the procedure took place for damages in excess of $75,000. Stowell's case will be helped by the landmark case won by David Llewelyn, a lawyer currently handling 21 circumcision cases throughout the U.S. Llewelyn won his client a record $65,000 for a wrongful circumcision case in which the mother told the doctor not to circumcise her son, but the physician circumcised him anyway (Chester-Taxin 120).

"Often the less there is to justify a traditional custom, the harder it is to get rid of it." -Mark Twain

The poorest argument of all for circumcision, yet the most popular is that everyone is doing it. The same mothers who will someday ask their sons "if all your friends jumped off of a bridge, would you do it too?" are lining up on a bridge of their own and taking their sons with them. Boys do not need to look genetically like their peers to fit in. With the rapidly declining rate of circumcision in the U.S. the chances are nearing 50/50 that his best friend will be intact (Ritter 21). With the circumcision rate hovering at just under 60% no matter what decision a parent makes, the son will differ from at least 40% of his peers. In western states such as California where the intact boys outnumber the circumcised by 20% the question being asked of parents is still "Why am I different?" but it is now being asked by circumcised boys and followed with "Why did you let them cut off part of my penis (Ritter 21)?"

A doctor's responsibility in helping parents make a decision on whether to circumcise their son ends when all of the pertinent medical information has been given to the parents. Yet many doctors continue to try and persuade parents to circumcise based on their own personal feelings. The following account tells how doctors use the power of conformity to try to influence parents. "When my wife was expecting a baby, I was undecided about circumcision, while she was against it. After my son was born, the doctor asked me if I wanted to have him circumcised. He reviewed arguments about hygiene and health, but I was still unconvinced. In a final effort to persuade me, he asked, 'Don't you want your son to look like you?" That question was enough to help me decide. I told him, "I'm not circumcised (Goldman 65)."

The argument that a son should match his father is foolish. Edward Wallerstein asks, "If a boy's father is tattooed or has an appendectomy scar, or wears eyeglasses, should the child be similarly provided?" When parents circumcise to conform, they take for granted such variables as whether the child will even care if he matches his father or how the child will feel about the choice his parents made as he gets older and learns for himself about circumcision. Fathers are also prone to the "I'm circumcised and I'm fine" point of view. As far as most men are concerned, if they can get erect and have an orgasm, then they are "fine." As it was mentioned earlier though, removal of the foreskin means that a man will miss out on feelings and sensations only experienced by the intact, yet because they have never felt these feelings, circumcised men have no basis for comparison. If a man were colorblind and never learned about colorblindness, the man would believe that what he s ees is normal and that his eyesight was "fine." It would take a great amount of courage and honesty for a circumcised male to admit that his penis, a cherished part of his being, was not all it was meant to be (Ritter 17). One father expresses his own feelings of being different by saying, "What was so difficult in leaving my son intact was not that my son would feel different in a locker room, but that I would feel different from him. I would then have to accept that I'm an amputee from the wars of a past generation (Goldman 70)."

The ethnocentrism practiced by Americans is also a contributing factor in our societies inability to see the cruelty of circumcision. The United States is the only western country that still routinely circumcises for nonreligious purposes. American doctors continue to tell parents of the perils that would plague their sons if they did not circumcise, yet circumcision is almost nonexistent in European countries and they have not suffered from these purported evils.

"Never doubt that a small group of committed citizens can change the world. Indeed, it is the only thing that ever has." Margaret Mead

Clearly, the routine circumcision of infants has no place in a civilized society. Parents must be educated so they can make the informed choice to leave their son intact, the way nature intended. Circumcision is an expensive, dangerous, and unnecessary procedure that has severe repercussions and risks for the infant being operated on.

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